FACT:

Managed care commands by far the largest share of the pharmaceutical prescription market.

Currently, 80% of the U.S. population is enrolled in a managed care organization or other third-party payor. These customers now influence over 85% of the Rx drug business. Enrollment is positioned for continuing growth.

FACT:

The impact of managed care on physicians is enormous.

In the U.S. today, 87% of MDs have at least one managed care contract. Sixty percent of MDs have 5 or more managed care contracts. Sixty-five percent of MDs say they are practicing in an area of high managed care penetration. It is not unusual for 35% of a doctor's practice to belong to the same managed care organization.

FACT:

To be successful, managed care organizations must provide consistency and quality of care across its network of caregivers and members, while controlling costs.

To help achieve cost control, MCOs use formularies, Drug Utilization Review (DUR), financial incentives, treatment guidelines, and capitation to influence member physicians' prescribing behavior.

FACT:

Over 110 million managed care organization members are covered by "closed" formularies.

This typically requires caregivers to exclusively prescribe and use approved products and services. An additional sixty million people are covered by managed care organizations with open formularies. Some managed care organizations may use capitation as the only tool to control pharmacy costs at the primary caregiver level. 

FACT:

Managed care organizations use a per-member capitation payment structure for physicians within their plan networks.

Capitation is when a managed care organization allocates a set amount per member/per year a physician receives for that plan’s members who choose that doctor as their primary care physician.

	Under this agreement, the physician must provide the full range of primary care services to plan members for one year out of that allocation. This motivates the physicians to deliver quality care at the lowest possible cost
	Guidelines that encourage and support a specific product as routine first-line treatment are of great value to these capitated physicians

FACT:

Managed care does business differently.

Managed care is a field with unique organizational dynamics, regulations, and decision- making processes. Gaining access to the decision makers can be particularly difficult for a company attempting to penetrate these markets.

	Customers within the managed care industry are not always receptive to working with another new account manager. This can be a major obstacle for newcomers, particularly for smaller pharmaceutical companies
	Virtually every MCO has its own, unique approval process. Navigating the individual processes is highly complex and demands full knowledge to succeed in gaining access and negotiating contracts

With in-depth knowledge of the people, policies, regulatory constraints, and the managed care organization’s structure, MC Access has the experience, know-how, and relationships with senior management necessary to successfully penetrate this market for its pharmaceutical clients.